Provider Demographics
NPI:1861836553
Name:BODEA, JOANNA I (DMD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:I
Last Name:BODEA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 STATE BRIDGE RD STE L
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6427
Mailing Address - Country:US
Mailing Address - Phone:678-474-4917
Mailing Address - Fax:678-474-0244
Practice Address - Street 1:5805 STATE BRIDGE RD STE L
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6427
Practice Address - Country:US
Practice Address - Phone:678-474-4917
Practice Address - Fax:678-474-0244
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist